Volume 8, No. 2: Section 8, Autumn 2006

SELAM Mentors

Cynda Johnson, MD, MBA

Cynda Johnson

Congratulations to Dean Cynda Johnson, MD, MBA, the newly elected Chair1 of the Board of the American Board of Medical Specialties (ABMS). She is the first woman as well as the first Family Medicine physician to lead in the position of Chair of the Board of ABMS. ABMS is the overarching, umbrella organization for all the boards of medical specialties in the United States.

During her two-year term (March 2006 – March 2008), Dean Johnson is striving to facilitate the collaboration of all the national specialty boards’ work on the ongoing monitoring of physician competency. Another goal is maintaining a voice to support the importance of diversity on the ABMS Board. During her past 2 years as Vice-President, she worked on the issue of broader representation on the Board. Steadfast in her efforts for diversity, she is eager to inculcate broader representation on the ABMS Board as standing policy.

Early in Her Career
When Dr. Johnson was a junior faculty member in the Department of Family Medicine at the University of Kansas, her priorities were to raise her children, balance family needs and time with her helpful spouse (also a physician) and achieve promotion and tenure. When her children were nearly college age, she earned an MBA (Master’s in Business Administration) to gain skills in finance. Previously she had avoided financial management tasks. Yet she knew, as many fledgling leaders know, that she needed to understand business and financial management tasks before delegating these responsibilities, in order to provide responsible planning and budget oversight as her career expanded.

Dr. Johnson endorses one early career goal for others: be involved always in at least one professional organization. She advises women to keep one finger (or toe) in a professional organization, even when their career is starting, when family duties take up so much time, and especially when the children (and/or pets) are young.

Surprise Nudges toward Leadership
One day very early in her career, during a Departmental meeting, Dr. Johnson sat across from her Chair who hailed from her hometown and had left his community practice to become Chair. He stated, “One day you are going to be in this chair…” She was shocked that he should think that. She never forgot those words as she progressed in her career. In January 1998, she became Interim Chair at the University of Kansas. In May 1999 she completed the MBA. In November 1999 she became Chair of Family Medicine at the University of Iowa.

After a short while, her Dean and the hospital CEO, impressed with her budget and management skills, told her in so many words that it was time for her to prepare to become a Dean. Again, the words caught her by surprise. The Dean and the CEO mentored her over a period of four years. Sometimes they offered her opportunities, such as chairing committees and managing small budgets, which she appreciated. When they offered opportunities for expanded experience, such as chairing the Board of Practices owned by the university, she liked the invitation but balked at taking over ownership of three of the practices the following year. When she respectfully declined, they assigned her the task. They helped her to see the error of her respectfully declining these expanded learning opportunities by negotiating potential additional resources for her Department in exchange for her accepting this additional “professional growth” management experience. Her skills to negotiate for resources essential to do her job bode well for the expanded assignments and career growth. She is now Dean at the Brody School of Medicine, at East Carolina University in Greenville NC.

Her self-appointed mentors helped her become committed to ongoing mentorship. Her trail of mentors, however, started early in her youth with her first mentors, her parents. Her parents from rural Southeast Kansas were hard-working “salt of the earth” people, who instilled a strong sense of worth in their only child. They encouraged her to discover her passions and follow them. They nurtured confidence in their child, confidence that she could pursue whatever she wanted to do. As a result she was the first member of her extended family to attend college.

Mentoring Others
As a way of passing the baton, Dean Johnson is committed to mentoring others. A few years ago as Chair, she became aware that too many women faculty in early or mid-career levels were announcing plans to leave academic medicine. This is a widespread problem. Instead of discussing their dilemmas early with academic advisors or leaders who could provide guidance or strategies for resolution, women faculty kept their problems private. Their stories stayed closeted, hidden from people who could help them problem-solve. Dean Johnson’s approach is to mentor junior and female faculty early with preventive measures that involve unveiling potential issues, describing possible interventions, discussing strategies to solve problems, and providing ways to plan ahead.

Her experience is that women faculty tend to be highly motivated and eager to work on research, clinical services, educational needs, and committees. They want to serve as strong change agents. These women faculty need help to avoid becoming over-committed. They need help balancing professional activities with personal needs and family demands on their time and energies. Instead of backing off from lower priorities and reorganizing their schedule, they become over-committed and then overwhelmed. When women faculty announce to their Chair or Dean plans to depart from academic medicine, Dean Johnson is convinced that they have already planned and have a firm mind-set to exit. At that point, in their head, they already have moved on. A mentor may help a faculty member avoid the path that leads to becoming overwhelmed.

Dean Johnson believes that mentors should receive training, especially in helping mentees develop a career plan, mentor-skills in providing direction but not directives (thus avoiding micromanagement of mentees), and guiding mentees toward their long-term goals. Dean Johnson recommends that experienced people serve as mentors. Thus, a dean may mentor associate and assistant deans as well as chairs. A chair may mentor senior and junior faculty while senior faculty may mentor junior faculty.

One principle that Dr. Johnson stresses is to avoid always agreeing with the mentee. Always validating them may misdirect mentees. Backing up the process by asking them to think about their immediate and long-term goals, what steps are needed to achieve those goals and what strategies will work to achieve those long-term goals help to guide perspective toward each bigger and long-term goal. The mentee should come up with the tactics for the actual process, but the mentor may help frame how the activity or tactics lead to the professional goal and how the results may impact personal life.

Rewards for Mentoring
Dean Johnson believes that mentoring should be an expected responsibility of the faculty and academic administrators. The success of the mentee, not money, should be the reward for mentor efforts. Not everyone is appropriate to serve as a mentor. Some people are more facile and experienced than others at mentoring; training helps develop good mentor-skills. It is important for a mentee to find a good mentor and for the match to work for both people.

Learning from Mistakes
Two mistakes served as initial barricades to her professional growth and success until Dr. Johnson learned skills to address these issues.

Mistake #1: Not understanding the political setting. Politics are important in so many settings, including academic medicine [See Janet Bickel’s article on “Hard Work and Talent Aren’t Enough: Developing Political Savvy” in this issue]. Learning about the political climate of a setting, such as how, when, and with whom to do business, is important. Her MBA courses offered some training on politics in the business environment. As Dean, Dr. Johnson recognized the need as a newcomer to learn more about institutional politics, to understand the political environment and to understand how things were done. Though some people have innate political sensitivity and competence, Dean Johnson is convinced that “…it is essential to know that these skills can be learned. This is an intentional skill set.”
This skill set includes negotiation skills, how to the ride the ebb and flow of talk appropriately (as a kite ripples in the wind), to know where and when people talk to each other, to learn how they talk to each other and what is acceptable to say, and when to move from superficial social greetings to deeper work-related topics.
Coming from a culture and having a personal style of being straightforward and open, Dr. Johnson learned to apply her objective skills used in the clinical setting to an objective assessment of different environments, cultures, and people. She acquired appropriate bridging skills. For example, she learned about timing: when she should nudge people, when she should take smaller steps toward a goal, and when she should allow more time for points of discussion and plans to simmer before initiating action steps.
She recommends an executive coach for people who reach later career goals. Her coach helped her understand a rubric: what worked before in a previous environment and previous job assignment may not work in the new setting and new position. This proved to be true in her move from Chair to Dean.
Mistake # 2: Not playing golf. Dr. Johnson soon realized that many decisions occur on the playing field. She did not play golf. For example, when serving on the American Board of Family Medicine, which was always held at golfing resorts, she often stayed in her room and worked on her MBA coursework. While she hovered over assignments, colleagues were out on the golf course deepening relationships and “cutting deals” with leaders in academic medicine. She never learned to play golf. Now she lives on a golf course, thinking she would learn...somehow…some day. Meanwhile she tries to find other playing fields and encourages mentees to learn about the interests and hobbies of their Chairs, Deans, etc. to find ways to cultivate those important relationships.
The folks at Brody School of Medicine have done just that. Dean Johnson has a serious interest in cooking. She is just amazed at the number of people at the school who now share this vocation. And they have such interesting conversations at academic gatherings. It gives one “food for thought”!

In fact, throughout the interview, Dean Johnson provided much pragmatic food for thought:

Contact information for Cynda Johnson, MD, MBA, Dean, Brody School of Medicine at East Carolina University, 600 Moye Blvd., Greenville, NC 27834; (252) 744-2265, JoEllen Reel, secretary.

Leilani Doty, PhD
University of Florida

1)The ABMS Board recently changed some of its organizational structure. One change involved renaming its officer titles from president and vice president, etc. to Chair and Vice Chair. The purpose was to facilitate the movement toward the goal of Maintenance of Certification. (All national specialty boards are working together toward ongoing monitoring of physician competency.)

Interview of a Mentor: Susan Potts Sloan, MD
Associate Professor of Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City TN
President, Association of American Indian Physicians

Brief Bio: Susan Potts Sloan, MD, traveled a circuitous path to become the first in her family to attend college and become a physician. Although she knew by the age of four that she wanted to become a physician, her high school guidance counselors later discouraged her from a medical education. Thus, she became a certified teacher in 1972. From 1979 to 1994, she worked as the Associate Director of Children First in Hendersonville TN. During that period (1986) as a professional childbirth educator, she designed and instituted hospital birthing and sibling-at-birthing classes throughout the middle Tennessee area. She also served as a montrice, enhancing the deliveries of numerous babies in that region.

An unspecified number of birthdays later (in 1994), while pregnant with her fifth child and with strong support from her spouse and family, Dr. Sloan began her pursuit to achieve her lifelong dream to become a physician. On the day her youngest started kindergarten, she started medical school as a "chronologically enhanced student" at the University of Minnesota. Dr. Sloan completed her internal medicine residency in 2001 at the Berkshire Medical Center in Pittsfield MA, where she also served as Chief Medical Resident. Simultaneously, she served on the board of the Elizabeth Freeman Center and as the medical director of Health, Education, Resource, Outreach and Advocacy (HEROA). She accepted an appointment as assistant professor of medicine at the University of Massachusetts and served as the Director of Ambulatory Medicine. She then joined the faculty of Internal Medicine at East Tennessee State University (ETSU) where she served as the Associate Program Director of the Internal Medicine Program until July 2006.

A strong advocate to address disparities, she has provided leadership for medical students, Native Americans, and the underserved, and served on several national committees addressing each of these issues. She founded Preterm Connection, a nonprofit that served women at risk for premature labor and delivery. In March 2006, Dr. Sloan was honored with an appointment to the National Institutes of Health Advisory Committee on Research on Women’s Health. Dr. Sloan spoke on "A Solution to the U.S. Physician Shortage: Diversity in Medical Education" at the Minority Access Conference, prior to testifying before a US Congressional hearing on September 28, 2006. In December of this year, she will make her first international presentation in New Zealand, where she will be addressing the implications of the Women’s Health Initiative and other studies on indigenous women and their health challenges.

Who are the people who have most influenced you in your professional career, particularly in academic medicine (or a related academic area)?
I’ve been blessed by the presence of many influential men and women throughout my career in medicine. Two of the most influential entered my life before I started medical school. I met Dr. Vivian Pinn in 1993. This woman – now one of nation’s leaders in women’s health – encouraged me to face my challenges head on and to keep my eyes set on the finish line. As the first black female in her class, she made it through successfully, and she inspired me to as well.

Dr. Gerald Hill from the University of Minnesota was director of the Center for American Indian and Minority Health. He recruited me to UM and made sure there were support systems to help retain non-traditional and minority students like myself. Hill inspired me to reach beyond my role as a primary care physician and to pursue a career in academic medicine and to assume progressively challenging roles of leadership.

I’m proud to say both Drs. Pinn and Hill are still part of my life today.

What do you think are the core qualities of being a leader?
Successful leaders must have a strong sense of ethics and integrity beyond reproach. They should be visionaries capable of inspiring others. Good communication and listening skills are a must. A solid work ethic and a sincere respect for others and their ideas are important characteristics of a successful leader. Although strong leaders are effective facilitators in the decision process, they must be willing to make unpopular decisions at times and be accountable for those decisions.

How do you think individuals become excellent leaders?
Having a strong role model helps. One has to be willing to stretch beyond one’s comfort zone and accept progressively more challenging roles. Having organized, disciplined and methodical work habits make it easier to accomplish goals required to go from one level to the next. Assisting others to become more successful ultimately provides a bridge for you to advance as well.

What challenges and opportunities do you see for women in academic medicine/health sciences/top university leadership positions?
Because the limitations on women have been so great, the challenges remain vast. Overall, we are not quite “there” yet as far as having women in an adequate number of leadership roles. Yes, the “good ole boys” network still exists. If you are minority women, it is even more challenging. It is hard to be the “Golden Boy” when you are neither golden nor a boy. We’ve made progress, but there is yet more work to be done. But never forget that with great challenges come great opportunities as well!

How can we attract more women to academic medicine (or a related academic area)?
Academic institutions should place greater emphasis on recruiting women for academic faculty positions. But before doing so, schools need to evaluate their infrastructure. Is the climate supportive for women? Can women succeed? The answers to these questions must be “yes” before recruitment and retention efforts can be successful.

How can women move into leadership positions in academic medicine (or a related academic area)?
The most critical element is the institution’s intent to move women into leadership positions. Choosing the right woman for the right job and giving her the right support are equally important elements.

What has been the biggest challenge for you as [fill in your position]?
At every level of my progress, as for most women, the most challenging issues have been locating the right institution and support mechanisms. I have occasionally been stifled instead of supported. Thankfully, support from a few good colleagues, family and friends have kept me both balanced and motivated.

How do you keep your mind fresh? How do you manage stress and avoid burnout?
Networking with others who are passionate about medical education has been pivotal. Professional organizations are a great place to interact with colleagues across the nation. It’s energizing. Even if travel budgets prohibit you from attending national conferences, you can still get involved with colleagues through discussion groups.

It is also important to find a hobby that you enjoy. Most physicians aren’t blessed with ample free time, but everyone should find time for some type of creative outlet. I enjoy spending time with my family and my horses. I’m also a theatre buff. I make time to attend professional shows as well as local productions at the community theatres.

What do you consider one of your recent major accomplishments? How have you managed this? How has it benefited your institution?
Stepping into the role as President of the Association of American Indian Physicians has been a major highlight of my career. I attended my first AAIP conference as a 1st-year medical student. Organizations like AAIP are powerful and have the potential of changing lives. It certainly changed mine! After being a member and president of the Association of Native American Medical Students (AAIP), I joined AAIP and subsequently served on various committees prior to being elected to the office of Secretary and then President-Elect. I consider it an honor to lead such a valuable and worthwhile organization. It has afforded me multiple opportunities to advance the access to quality health care as well as quality medical education. One example: I spoke before a US Congressional Hearing in September 2006 to address the Title 7 funding cuts. This issue impacts many medical schools across the nation, including ETSU. I will be advocating for funding for programs like HCOP and Centers of Excellence. Access to good health care is predicated by access to good medical education.

What is/are your priority in your career? How will you expand in this area?
Medical education is my great passion as it marries two of the leading forces in my professional life. My career goals include identifying new ways that medical education can be enhanced, advanced, and supported.

What are the important elements in being a good mentor and being a good mentee?
As a mentor, your door must always be open. From the start, you must set ground rules. Don’t be intimidated at times when you must be honest. A mentor is not a cheerleader. You must help your mentee build on his or her strengths and improve the areas that may be weak. An honest assessment of a problem is the first step to its resolution.

If you are a mentee, I salute you. You’ve realized the importance of having a mentor. Your selection of the correct mentor(s) is the critical “rate-limiting step”. If mentors are unwilling to speak with candor and advise rather than just be a sounding board, choose someone else. If they are able to speak frankly, then listen. You may hear things that you don’t want to hear. Rather than become defensive, reflect on what you hear. This is a powerful opportunity to advance as a person and as a physician. However, if their take on an issue doesn’t resonate with you, do not be afraid to listen to your gut. The ultimate decisions remain with you.

Be prepared to give back. Some day, you will be a mentor, too.

Leilani Doty, PhD
University of Florida

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